| NPI | 1285292383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP04789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT217986) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2026-06-29 |