| NPI | 1972918738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 84985-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105183) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2025-01-22 |