| NPI | 1134407307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109374) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL 109374) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2017-04-24 |