| NPI | 1457516254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD13698) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2020-01-14 |