| NPI | 1760620975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 245843) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD13372) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2020-01-14 |