| NPI | 1700828266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: WV 19793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 19793) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-04-02 |