| NPI | 1861767113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS12935) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q9366) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2020-03-10 |