| NPI | 1326257593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME113861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 10006) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-10-18 |