| NPI | 1639551476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD22124) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264151) |
| Enumeration Date | 2015-06-28 |
| Last Update Date | 2018-11-30 |