| NPI | 1710073648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 0048270) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0048270) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL ME0048270) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-12-13 |