| NPI | 1134581051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 40755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 277661) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-06-30 |