| NPI | 1881251668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 88694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 101279) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-10-22 |