| NPI | 1619097805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 293D00000X Physiological Laboratory |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 79380) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2026-02-18 |