| NPI | 1255542262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 29685) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-07-10 |