| NPI | 1659955664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS20857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL83502) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2024-07-02 |