| NPI | 1093237786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME165828) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 34654R) |
| 207R00000X Internal Medicine (Licence: PR 33359) | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2024-08-19 |