| NPI | 1710304449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 274345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15935) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2018-11-05 |