| NPI | 1174865562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD044529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD19342) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2023-07-10 |