| NPI | 1780871970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 234084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 37478) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2022-11-18 |