| NPI | 1659711893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME130896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.063997) |
| 207R00000X Internal Medicine (Licence: IA MD-44270) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2024-02-21 |