| NPI | 1528065745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD05292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD 05292) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2020-02-25 |