| NPI | 1073731428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 070138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 70138) |
| 207R00000X Internal Medicine (Licence: MI 4301088005) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-01-07 |