| NPI | 1083230916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP05091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 31715) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-06-29 |