| NPI | 1780004705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-01927) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2020-03-19 |