| NPI | 1275928384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-00158) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 081271) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2022-02-14 |