| NPI | 1871588947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD18319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD061067L) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-05-09 |