| NPI | 1205028412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD202105) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA getp.lsu.im) |
| Enumeration Date | 2007-08-11 |
| Last Update Date | 2022-03-15 |