| NPI | 1053441477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI DO00688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME 2148) |
| 207Q00000X Family Medicine (Licence: ME 2148) | |
| 207Q00000X Family Medicine (Licence: RI DO00688) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-08-06 |