| NPI | 1629244231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 125724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 031307) |
| 207R00000X Internal Medicine (Licence: CA G41317) | |
| 207R00000X Internal Medicine (Licence: VA 0101232778) | |
| Enumeration Date | 2008-05-03 |
| Last Update Date | 2024-07-02 |