| NPI | 1003128760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 077659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 245655) |
| 207R00000X Internal Medicine (Licence: UT 8623977-1205) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2020-04-16 |