| NPI | 1487037339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D85950) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P00033) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2018-09-21 |