| NPI | 1710521208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C174258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD16837) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2022-06-24 |