| NPI | 1932832599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD20792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351049501) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-07-07 |