| NPI | 1992079867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 81794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 112174) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2020-10-29 |