| NPI | 1306837257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128206) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 12081) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2020-03-04 |