| NPI | 1265415194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD08573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD444276) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2025-08-26 |