| NPI | 1558822544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101276718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN28174) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2022-12-28 |