| NPI | 1528370368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 73905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 46216) |
| 207R00000X Internal Medicine (Licence: FL TRN14646) | |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2023-06-19 |