| NPI | 1700141017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 96080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02649) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2023-08-03 |