| NPI | 1235361080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD14026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT 195469) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2023-12-13 |