| NPI | 1659772622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: FL ME 120423) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 120423) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2015-08-21 |