| NPI | 1255693156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS12439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO3013) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-03-07 |