| NPI | 1477627545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI EMC0002839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102202637) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-06-27 |