| NPI | 1720096928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 29784020) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 29784-020) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2025-04-30 |