| NPI | 1467590703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 019732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD20347) |
| 207R00000X Internal Medicine (Licence: MA 1021646) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2025-12-08 |