| NPI | 1992818629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME97664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15827) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-01-21 |