| NPI | 1609433861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 71172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04603) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-06-23 |