| NPI | 1801094271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: NC 2004-00226) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2004-00226) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2024-02-19 |