| NPI | 1316366321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 273178) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD17269) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2021-06-30 |