| NPI | 1992012637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 18046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108842) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2020-09-03 |