| NPI | 1912973223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 80872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TPME6615) |
| 207R00000X Internal Medicine (Licence: SC 92674) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-09-13 |