| NPI | 1215264536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18208) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2021-07-06 |