| NPI | 1306209234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS20194) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 70264) |
| 207R00000X Internal Medicine (Licence: NY 299206) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2023-09-29 |