| NPI | 1508841081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD10134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 160319) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2020-04-24 |