| NPI | 1407900400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101050599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 155019) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2022-04-29 |