| NPI | 1174939060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 77626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105676) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2022-07-21 |