| NPI | 1982157830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101279094) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D876189) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2023-12-12 |