| NPI | 1588688717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301060629) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301060629) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-07-24 |