| NPI | 1578753646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME137704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 200701341) |
| 282N00000X General Acute Care Hospital (Licence: AR E 663O) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2019-12-16 |