| NPI | 1922412881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD15743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-2698) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2024-04-09 |