| NPI | 1609258896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 275126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263872) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-12-22 |