| NPI | 1962077263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101281246) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351047534) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2024-06-22 |