| NPI | 1265963698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 14528A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MRO-1871) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-02-10 |