| NPI | 1801388970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD17518) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04359) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-07-02 |