| NPI | 1023422607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: MA 270162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD17833) |
| 207Q00000X Family Medicine (Licence: MA 270162) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2022-03-10 |