| NPI | 1134435530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 80328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 46166) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2024-07-30 |