| NPI | 1386662757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD d0062123) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101279176) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-09-26 |