| NPI | 1306890611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0066102) |
| Additional Taxonomies | 202K00000X (Licence: MD D0066102) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-08-24 |