NPI | 1629464748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD16268) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 60758) |
Enumeration Date | 2015-04-15 |
Last Update Date | 2023-02-17 |