| NPI | 1508395559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 67300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10944) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2020-06-29 |