| NPI | 1225178825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 068373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME84326) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-01-30 |