| NPI | 1215986682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301070993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI PG070993) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2021-11-02 |