| NPI | 1861757387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101258053) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252614) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-08-12 |