NPI | 1104054261 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO00835) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 254236) |
Enumeration Date | 2009-06-29 |
Last Update Date | 2019-05-07 |