| NPI | 1699174680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-00669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105628) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2022-01-12 |