| NPI | 1689762080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN10009) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-02-11 |