| NPI | 1790305399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301508800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046472) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2023-05-16 |