| NPI | 1669029377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 22315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 34508R) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2022-03-02 |