| NPI | 1619143849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301087402) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D68782) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2022-09-16 |