| NPI | 1316924897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD10174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 216396) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2014-01-07 |