| NPI | 1831122647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0045471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 21540) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-07-21 |