| NPI | 1467758912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME1199599) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2021-10-14 |