| NPI | 1083654669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101240760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 36119) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-01-12 |