| NPI | 1255691291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 266045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02450) |
| 208000000X Pediatrics (Licence: RI LP02450) | |
| 208000000X Pediatrics (Licence: MA 266045) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2016-06-27 |