| NPI | 1558336016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 220372) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: RI MD10853) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2020-12-07 |