| NPI | 1033775655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 314436) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04555) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2022-06-28 |