| NPI | 1376292193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD20550) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MMD.87769) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2025-05-09 |