| NPI | 1518489996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OR MD208412) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272102) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-11-16 |