| NPI | 1356791131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 320583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P32680) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2019-09-19 |