| NPI | 1700316668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 65170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD17208) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2026-01-29 |