| NPI | 1386084630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017017854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15523) |
| 207R00000X Internal Medicine (Licence: IL 125.063541) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2022-07-21 |