| NPI | 1093754780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 270103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO00518) |
| 208D00000X General Practice (Licence: RI DO00518) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-01-18 |