| NPI | 1740803360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD20023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD481703) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2024-05-24 |