| NPI | 1205498482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 83805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD19145) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: RI MD19145) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 83805) | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2026-04-16 |