| NPI | 1255444857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 249761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP00174) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-08-22 |