| NPI | 1255619052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 53059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15028) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2025-03-13 |