| NPI | 1750877221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 289378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04432) |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2021-11-17 |