| NPI | 1265971311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 24115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL HSE 24115) |
| 363AM0700X Physician Assistant, Medical (Licence: 000143-PA) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2019-09-02 |