| NPI | 1588073795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106018) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD09011) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2014-08-13 |