| NPI | 1144265117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01051081A) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-12-02 |