| NPI | 1376959742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME133089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 19676) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2024-02-09 |