| NPI | 1235457391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 129902) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 20617) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2017-02-09 |