| NPI | 1770923492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2019-00007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102879) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-09-24 |