| NPI | 1609163815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME146192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199338) |
| 207R00000X Internal Medicine (Licence: PA MD452483) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2024-05-31 |