| NPI | 1548474778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD16998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A91050) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2026-05-26 |