| NPI | 1942863550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 336439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101026478) |
| 207R00000X Internal Medicine (Licence: MI 4301507297) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2023-09-22 |