| NPI | 1851851901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1016008) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD18885) |
| 207R00000X Internal Medicine (Licence: NH LT4397) | |
| 208D00000X General Practice (Licence: RI MD18885) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-10-05 |