| NPI | 1740575109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI DO01006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 259434) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2025-07-22 |