| NPI | 1700231024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102205512) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102205512) |
| 207R00000X Internal Medicine (Licence: PA OT016981) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2023-10-24 |