| NPI | 1730159500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD07148) |
| Additional Taxonomies | 208D00000X General Practice (Licence: RI MD07148) |
| 207Q00000X Family Medicine (Licence: MA 55248) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: RI MD07148) | |
| 208D00000X General Practice (Licence: MA 55248) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-08-02 |