| NPI | 1386026193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101021567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC D051971) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-09-08 |