| NPI | 1437786902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 95071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12352) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-03-29 |