| NPI | 1205241833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 77748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT207622) |
| 207R00000X Internal Medicine (Licence: FL ME130915) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-09-20 |