| NPI | 1407203490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD16985) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03677) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2020-07-30 |