| NPI | 1386626174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: RI MD05654) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: RI MD05654) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: RI MD05654) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2016-09-09 |