| NPI | 1326401860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 320114) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 302550) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-05-06 |