| NPI | 1205940566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD13073) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP00920) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-01-14 |