| NPI | 1780069930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 71936) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD16238) |
| 207R00000X Internal Medicine (Licence: RI LP03487) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2024-08-21 |