| NPI | 1922254531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 21564) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101025823) |
| 207R00000X Internal Medicine (Licence: AK 163395) | |
| 207R00000X Internal Medicine (Licence: OH 34.00974) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2021-01-19 |