| NPI | 1245527845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD14622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI lp02361) |
| Enumeration Date | 2011-07-02 |
| Last Update Date | 2020-10-23 |