| NPI | 1144566712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201700737) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC md91489) |
| Enumeration Date | 2012-12-29 |
| Last Update Date | 2024-06-03 |