| NPI | 1073762043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100206) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL ME 100206) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2020-12-17 |