| NPI | 1023675055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 80128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04544) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-06-27 |