| NPI | 1073789301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101276627) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094912) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2022-12-15 |