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 |