| NPI | 1013986140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD19533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 216386) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-12-06 |