| NPI | 1073967527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN22736) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2019-09-23 |