| NPI | 1568807584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GU M2066) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 019743) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2018-11-14 |