| NPI | 1487149787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301502797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115933) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-08-05 |