| NPI | 1306171749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112868) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 27455) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2023-12-27 |