| NPI | 1124245782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088293) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2015-10-14 |