| NPI | 1962722454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME141372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 273192) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2020-11-11 |