| NPI | 1760045462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5151013421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 4704) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2022-09-13 |