| NPI | 1457353799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 56357) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2019-08-13 |