| NPI | 1609040757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 121187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18248) |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2016-02-26 |