| NPI | 1215321146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD045923) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 324735) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2024-01-25 |