| NPI | 1952565889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI 13146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 046677) |
| 207Q00000X Family Medicine (Licence: FL 143488) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2020-11-03 |