| NPI | 1902213879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD15776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260470) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2018-08-01 |