| NPI | 1902855505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME40263) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME40263) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-01-27 |