| NPI | 1639716384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD16860) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD16860) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2020-01-08 |