| NPI | 1083137228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 28083) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN25732) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2020-10-15 |