| NPI | 1891101895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2020-00044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125065711) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2021-08-10 |