| NPI | 1487641411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1027654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO00368) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2026-06-12 |