| NPI | 1811519408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD19179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04836) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-05-01 |