| NPI | 1619320934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0016932) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 277660) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2023-06-22 |