| NPI | 1609031442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 237836) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2022-05-05 |