| NPI | 1629482864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A149416) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2024-06-10 |