| NPI | 1164710786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: VA 0101252328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA T63028072) |
| Enumeration Date | 2011-07-17 |
| Last Update Date | 2020-08-26 |