| NPI | 1518444181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME175839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 70175) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2025-08-27 |