| NPI | 1528435070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS15565) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116028751) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2019-08-09 |