| NPI | 1891719704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 00023677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 060128) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-04-29 |