| NPI | 1376559534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 93718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 38643) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-03-07 |