| NPI | 1124431044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: MA 270795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 13599-1) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-01-22 |