| NPI | 1083877518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102203353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02003810A) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2023-08-07 |