| NPI | 1083134019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61181360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP04110) |
| 207Q00000X Family Medicine (Licence: RI MD17011) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-06-29 |