| NPI | 1356348585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD 07900) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: RI MD07900) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2015-03-31 |