| NPI | 1225325764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301099418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM FELMD2020-053) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-02-11 |