| NPI | 1932339595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101251667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094567) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2020-12-11 |