| NPI | 1124281332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD13709) |
| 207Q00000X Family Medicine (Licence: PA MT193198) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2021-11-23 |