| NPI | 1043690183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301116864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301107656) |
| 207R00000X Internal Medicine (Licence: MI 4351033557) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-01-03 |