| NPI | 1336136456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 150167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD09625) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-09-17 |