| NPI | 1982151015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 67228) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD16201) |
| 207R00000X Internal Medicine (Licence: NJ 25MA09952400) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2021-03-14 |