| NPI | 1912496209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD17512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI CMD17512) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2021-09-14 |