| NPI | 1619462157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 286767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018014954) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2021-07-21 |