| NPI | 1174015762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-01852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04282) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2024-04-15 |