| NPI | 1235621749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD17719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04269) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2021-06-06 |