| NPI | 1427602176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-02842) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019018155) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2024-01-16 |