| NPI | 1700148418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101255278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-03245) |
| 207R00000X Internal Medicine (Licence: GU M-1956) | |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2024-03-04 |