| NPI | 1902908023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD05295) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 40948) |
| 207Q00000X Family Medicine (Licence: CA G29136) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2023-05-02 |