| NPI | 1881700284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 231634) |
| 207R00000X Internal Medicine (Licence: RI LP00154) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-11-19 |