| NPI | 1336706621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD18294) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04580) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2022-11-30 |