| NPI | 1154704906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264115) |
| 207R00000X Internal Medicine (Licence: MA 277164) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-10-29 |