| NPI | 1053816066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD210001345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD20000065) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2021-06-29 |