| NPI | 1508094772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 250402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP01653) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-01-07 |