| NPI | 1003213604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME135332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105108) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2020-11-17 |