| NPI | 1154768281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 265504) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02789) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2016-06-28 |