| NPI | 1679951156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD16172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03426) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-05-07 |