| NPI | 1629465075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME133306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN21191) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-06-17 |