| NPI | 1982085106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301119237) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN# 23648) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2021-03-01 |