| NPI | 1669811311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME122012) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN19234) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2021-04-26 |