| NPI | 1891350971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101025939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102207568) |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2023-01-18 |