| NPI | 1558627455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 271631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD14935) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-03-15 |