| NPI | 1376735654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME120634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 21186) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2023-12-07 |