| NPI | 1831535491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS15109) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS15107) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2021-02-13 |