| NPI | 1992798599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD29034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 34056) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-08-05 |