| NPI | 1972616019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 239215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO00720) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-04-22 |