| NPI | 1295703445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO MDR5P58) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO R5P58) |
| Enumeration Date | 2006-03-12 |
| Last Update Date | 2020-12-04 |