| NPI | 1669888475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD15751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125064302) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2018-07-31 |