| NPI | 1245200633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL os8656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL DO751) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2022-02-04 |