| NPI | 1164064655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 76235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD18264) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2024-05-16 |