| NPI | 1982991881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101019296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO CDR.0000654) |
| 207R00000X Internal Medicine (Licence: IL 036.152224) | |
| 207R00000X Internal Medicine (Licence: NE 2162) | |
| 207R00000X Internal Medicine (Licence: KS 05-43057) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2020-11-18 |