| NPI | 1922313592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD14332) |
| 207R00000X Internal Medicine (Licence: CT 056507) | |
| Enumeration Date | 2010-08-08 |
| Last Update Date | 2023-09-11 |