| NPI | 1992771562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI MD08647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 1.075826) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2026-01-21 |