| NPI | 1720513971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 14270A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10970484-1205) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2022-11-02 |