| NPI | 1003878869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME118481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD072871L) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2024-04-08 |