| NPI | 1689296600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD19180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04874) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2023-04-21 |