| NPI | 1972916864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 21950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP03188) |
| 207Q00000X Family Medicine (Licence: WA MD60747854) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-10-07 |