| NPI | 1003253162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 76965) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02817) |
| 208D00000X General Practice (Licence: GA 76965) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2020-05-22 |