| NPI | 1689178824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD17880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 292338) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-08-28 |