| NPI | 1104069798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 028478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME102327) |
| Enumeration Date | 2009-04-12 |
| Last Update Date | 2015-12-18 |