| NPI | 1457972119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD27286) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046158) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2023-09-08 |