| NPI | 1972500429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 265658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD11072) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-11-06 |