| NPI | 1619081916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 235314) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP00005) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-11-24 |