| NPI | 1396311809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116036377) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.078392) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2022-07-27 |