| NPI | 1043474901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 102149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME102149) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2022-10-07 |