| NPI | 1134107915 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME38476) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0038476) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2020-10-29 |