| NPI | 1154505519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0019043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0001534) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2020-03-19 |