| NPI | 1104073345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D75757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01408) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2014-03-19 |