| NPI | 1699722827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.23353) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME71172) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2018-10-08 |