| NPI | 1700402583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 336040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020016969) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2023-08-09 |