| NPI | 1376573147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 030115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 30115) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-03-29 |