| NPI | 1780022236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD15343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP02879) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2016-08-11 |