| NPI | 1568561710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-35376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD14550) |
| 207Q00000X Family Medicine (Licence: IA 35376) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-08-29 |