| NPI | 1700857232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D47405) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0047405) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-08-28 |