| NPI | 1952547424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD17835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD425506) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2021-07-27 |