| NPI | 1184621138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD10232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI md1032) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2021-06-25 |