| NPI | 1578903654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127437) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204743) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2017-03-06 |