| NPI | 1215358510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI md15659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 286696) |
| 208100000X Physical Medicine & Rehabilitation (Licence: RI MD15659) | |
| Enumeration Date | 2014-01-04 |
| Last Update Date | 2023-05-09 |