| NPI | 1417971557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD16749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 11287) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-03-27 |