| NPI | 1164942504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD19130) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MA 284182) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2025-06-09 |