| NPI | 1841603263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 268910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 259306) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2019-02-27 |