| NPI | 1639464837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-00413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO00900) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2022-02-09 |