| NPI | 1285121764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 88907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS16835) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2023-02-13 |