| NPI | 1770782351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2007016870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.125523) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-12-20 |