| NPI | 1689787202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C133684) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD12889) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2015-02-05 |