| NPI | 1770862039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 291101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD15094) |
| 207Q00000X Family Medicine (Licence: HI MD19880) | |
| 207Q00000X Family Medicine (Licence: MO 2012026099) | |
| 208600000X Surgery (Licence: TX BP10039786) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-09-13 |