| NPI | 1851824163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 009853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 67563) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-09-07 |