| NPI | 1134212830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 230684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME83087) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-01-11 |