| NPI | 1386084267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 39244) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49288) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2024-07-03 |