| NPI | 1023678760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 21910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 34088) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2022-07-11 |