| NPI | 1356322234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0085763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL me0085763) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-11-05 |