| NPI | 1699128207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME146940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 21888) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2021-06-07 |