| NPI | 1073960159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60958731) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03666) |
| 207R00000X Internal Medicine (Licence: VA 0101266469) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2021-04-01 |