| NPI | 1720425838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284154) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 273365) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2021-05-10 |