| NPI | 1457365363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 038942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD11488) |
| 207Q00000X Family Medicine (Licence: CT 038942) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2023-03-07 |