| NPI | 1295161107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 057389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 14063A) |
| 207R00000X Internal Medicine (Licence: WY TL6788) | |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2021-11-01 |