| NPI | 1013114305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME122015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 64756) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-03-11 |