| NPI | 1558523142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 048089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD17015) |
| 207R00000X Internal Medicine (Licence: NY 244053-1) | |
| 207R00000X Internal Medicine (Licence: MA 250430) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2021-12-01 |