| NPI | 1356387823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 044658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD11594) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2018-08-17 |