| NPI | 1659513869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 244294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD13364) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2020-04-22 |