| NPI | 1124080254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD06717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI 06717) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2021-04-16 |