| NPI | 1508815606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 036228) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA GA036228) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2023-05-31 |