| NPI | 1942254297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD463426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 16282) |
| 207Q00000X Family Medicine (Licence: ME MD16579) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2020-10-11 |