| NPI | 1770581225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.11987R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA L11987r) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2021-08-10 |