| NPI | 1598388134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP04964) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD19182) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-04-05 |