| NPI | 1194069377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 131312) |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2021-03-29 |