| NPI | 1699194985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2024-0315) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA GA75398) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-04-08 |