| NPI | 1326339102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NC 2014-01043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-01043) |
| 207R00000X Internal Medicine (Licence: NH 23135) | |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2022-09-20 |