| NPI | 1407268956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 37638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS14351) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2021-09-09 |