| NPI | 1861000630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME160440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125076983) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2023-08-15 |