| NPI | 1932188216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2024043455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-0137) |
| 207R00000X Internal Medicine (Licence: OK 3050) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2025-01-20 |