| NPI | 1912959073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC 21581) |
| Additional Taxonomies | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: CA C184616) |
| 207R00000X Internal Medicine (Licence: MD D47927) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-03-17 |