| NPI | 1124322193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 127343) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18052) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2022-12-05 |