| NPI | 1669621215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 063080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME120196) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2022-06-14 |