| NPI | 1205817475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME93216) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME93216) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2012-09-01 |