| NPI | 1326595224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 63487) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD209932) |
| 207R00000X Internal Medicine (Licence: FL TRN22654) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2023-01-13 |