| NPI | 1629366380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2013-0831) |
| 207R00000X Internal Medicine (Licence: MI 4301098613) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2022-07-21 |