| NPI | 1033145859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME130323) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD13145) |
| 207Q00000X Family Medicine (Licence: MA 261491) | |
| 207Q00000X Family Medicine (Licence: NY 229263-1) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-10-04 |