| NPI | 1144283029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101225223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 32845) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-06-21 |