| NPI | 1245675222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2019-0697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 303070) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2023-07-13 |