| NPI | 1922283266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME108006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2005-01841) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2023-12-13 |