| NPI | 1649432857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 246064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 234171) |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2022-02-11 |