| NPI | 1598177297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP 03071) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP 03071) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2018-06-29 |