| NPI | 1518359298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.163832) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 71066) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2023-06-05 |