| NPI | 1184668618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115658) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: FL ME115658) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2026-08-20 |