| NPI | 1912248055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0101357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101257413) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2025-01-06 |