| NPI | 1356781314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.144556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 60528) |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2021-12-17 |