| NPI | 1356761704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132062) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.129773) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2020-08-10 |