| NPI | 1982676052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 152641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 12717) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2016-04-06 |