| NPI | 1851317622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-02415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC NC20130214) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-12-15 |