| NPI | 1881753986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 12792) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-10-29 |