| NPI | 1578022315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101270941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD210002590) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-03-26 |