| NPI | 1619539152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 333592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI CLP04777) |
| Enumeration Date | 2019-07-04 |
| Last Update Date | 2023-09-12 |