| NPI | 1619359288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136283) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015019699) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2018-08-10 |