| NPI | 1134142318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA 0S001780L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 05001780L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-12-08 |