| NPI | 1114236932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME117689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301097585) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2024-09-03 |