| NPI | 1346654407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 078835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL36863) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-07-21 |