| NPI | 1124555966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO195055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 40654) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-01-14 |