| NPI | 1801887617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 005526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 5526) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2018-02-05 |