| NPI | 1154616514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 257721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP02127) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2022-10-07 |