| NPI | 1508177841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 56871-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 56871) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2024-01-12 |