| NPI | 1720247976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME103366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt193285) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2014-12-02 |