| NPI | 1508022005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036-127118) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-055307) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-04-03 |