| NPI | 1740306943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 040900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS 6892) |
| 207R00000X Internal Medicine (Licence: GA 40900) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-03-07 |