| NPI | 1194349076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11899) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-07-12 |