| NPI | 1003170200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI ME168967) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2024-06-13 |