| NPI | 1366604555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT012719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204868) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2021-11-17 |