| NPI | 1104171925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A144275) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2026-07-27 |