| NPI | 1164873311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI CLP03821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2026-0405) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2026-04-13 |