| NPI | 1164560702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 78570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 78570) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL ME 78570) | |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME 78570) | |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2022-08-29 |