| NPI | 1003006503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-00579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301090347) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2021-11-10 |