| NPI | 1124063417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 148541) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 44409) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2025-04-23 |