| NPI | 1306959747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD12351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP00143) |
| 207Q00000X Family Medicine (Licence: UT 7272237-1205) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2021-10-26 |