| NPI | 1235475559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ACN864) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 19281) |
| 208D00000X General Practice (Licence: FL ACN864) | |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2021-10-27 |