| NPI | 1841857109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 315548) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04576) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-07-11 |