| NPI | 1104874320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI 4612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD04612) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-05-31 |