| NPI | 1174619878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD10391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD 10391) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-10-17 |