| NPI | 1326484221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101279732) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 84759) |
| 207R00000X Internal Medicine (Licence: NC 2016-00077) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2024-02-01 |