| NPI | 1972617744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 041448) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C160487) |
| 207R00000X Internal Medicine (Licence: IL 036.151442) | |
| 207R00000X Internal Medicine (Licence: ME MD23630) | |
| 207R00000X Internal Medicine (Licence: AL MD.43824) | |
| 207R00000X Internal Medicine (Licence: MS 15597) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2024-05-08 |