| NPI | 1659710507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI LP02926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267244) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-04-23 |