| NPI | 1639798267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO217191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 199627) |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2023-09-19 |