| NPI | 1245548643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 257165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD13461) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2026-02-06 |