| NPI | 1225324767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119744) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP02313) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-02-25 |