| NPI | 1306075072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112319) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: NY 265697) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: AL 33568) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: NC 2012-01268) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME112319) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2018-08-22 |