| NPI | 1467427575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 0050754) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0058048) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2024-01-15 |