| NPI | 1114009081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 14291) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 19408) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2021-05-04 |