| NPI | 1992169874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 158270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ZZ 0-945-236-8) |
| 207R00000X Internal Medicine (Licence: NY 309412) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-12-20 |