| NPI | 1174792899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME117155) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 17035) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2018-06-12 |