| NPI | 1306816921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD 036097E) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-05-21 |