| NPI | 1912923079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106053) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-115718) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-11-03 |