| NPI | 1962751396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD14981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275146) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2026-07-21 |