| NPI | 1063906428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 97417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301504425) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-05-16 |