| NPI | 1114339009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: WA 61025632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03115) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2023-04-18 |