| NPI | 1871080416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO6263) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2023-08-31 |