| NPI | 1760555882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2015-0734) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 17095) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-09-26 |