| NPI | 1821169186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 29957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 057136) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2023-08-31 |