| NPI | 1194827972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124498) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16534) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2023-10-20 |