| NPI | 1902096613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2009029861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2007016455) |
| Enumeration Date | 2007-07-29 |
| Last Update Date | 2024-03-21 |