| NPI | 1558324970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO00489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 270994) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2019-06-13 |