| NPI | 1639599194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR E-10781) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-01-24 |