| NPI | 1942445127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 080059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME135245) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2022-11-03 |