| NPI | 1700056769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME147959) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: FL 5755) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2021-08-02 |