| NPI | 1720051832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME89083) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME89083) |
| 204R00000X Electrodiagnostic Medicine (Licence: FL ME89083) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2025-12-17 |