| NPI | 1003299223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 88318) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301505591) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-08-11 |