| NPI | 1245646108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 260312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15858) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2017-06-14 |