| NPI | 1114901030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 221969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD10943) |
| 207Q00000X Family Medicine (Licence: MD D0064713) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2017-03-30 |