| NPI | 1891135208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.33761) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 23537) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2022-07-21 |