| NPI | 1023306230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-135959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 186) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2022-12-22 |