| NPI | 1851767552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102205021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116028755) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2017-08-11 |