| NPI | 1396193090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102206103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101022513) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-07-08 |