| NPI | 1629464748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD16268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 60758) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2026-06-08 |