| NPI | 1053632521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME136652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME136652) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2023-07-31 |