| NPI | 1912295502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 39911) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101019591) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-01-12 |