| NPI | 1972701571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-34238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB11625000) |
| 207R00000X Internal Medicine (Licence: NC 219294) | |
| 207R00000X Internal Medicine (Licence: MO 2010008637) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2022-10-06 |