| NPI | 1427614163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 292675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04518) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2026-06-26 |