| NPI | 1497742514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 72558) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD08048) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-04-27 |