| NPI | 1043208895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0076971) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0076971) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2020-11-18 |