| NPI | 1326038647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD11997) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 38219) |
| 207R00000X Internal Medicine (Licence: CA G156585) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2021-03-10 |