| NPI | 1447788021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 73258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 0000000000) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2020-12-30 |