| NPI | 1649621897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301109525) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101282463) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2024-07-23 |