| NPI | 1306054515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 98626) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL me98626) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2022-04-19 |