| NPI | 1124433347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 272995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260479) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2024-01-12 |