| NPI | 1629428644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 279139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO00962) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2024-10-18 |