| NPI | 1497983787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2014009218) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2009010808) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2020-10-30 |