| NPI | 1023216835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 37307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 16067) |
| 207R00000X Internal Medicine (Licence: FL ME98591) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-04-28 |