| NPI | 1316383565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 268742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 55679) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2019-10-07 |