| NPI | 1215457676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 307231) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04096) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2020-09-23 |