| NPI | 1801389580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: VA 0101277806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216060) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MI 4351048005) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2023-07-24 |