| NPI | 1104976141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A111144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD12719) |
| 207R00000X Internal Medicine (Licence: MA 230797) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-03-07 |