| NPI | 1386058915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125065049) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2022-07-21 |