| NPI | 1972759678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 286451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 256345) |
| 207Q00000X Family Medicine (Licence: CT 49791) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-11-30 |