| NPI | 1679605505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL PA9101559) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9101559) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2021-03-04 |