| NPI | 1356725105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21800) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2023-12-01 |