| NPI | 1124290465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 045879) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15671) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2017-01-12 |