| NPI | 1508399718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2020-01155) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 227616) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-07-11 |