| NPI | 1225463326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 55197) |
| Enumeration Date | 2013-09-08 |
| Last Update Date | 2024-01-04 |