| NPI | 1508990557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 64801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI 00414) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-01-09 |