| NPI | 1003821844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101238020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME95109) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2023-08-18 |