| NPI | 1295848331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N9339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP00914) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2012-01-27 |