| NPI | 1578944583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO01148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 294228) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-10-18 |