| NPI | 1336819705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME158717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.113493) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2024-03-01 |