| NPI | 1770542284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD14469) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 150246) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2016-04-14 |