| NPI | 1801878186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 34596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 212611) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2021-02-25 |