| NPI | 1972863827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME123533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN17337) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2022-07-21 |