| NPI | 1710168794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 53521-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 53521) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2023-10-23 |