| NPI | 1821083106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101237492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 39257) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2023-03-11 |