| NPI | 1568432292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME11778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 100592) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2018-10-17 |