| NPI | 1154588580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H00091853) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2021-06-14 |