| NPI | 1205814399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 050357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD10974) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2014-12-20 |