| NPI | 1548408867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA DO-05360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007018754) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2022-08-15 |