| NPI | 1063837292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 282933) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204325) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2022-07-21 |