| NPI | 1154419125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD12480) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 028404) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-06-05 |