| NPI | 1265875587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D83132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 1223) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-05-05 |