| NPI | 1740210798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME129765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD040653L) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-04-29 |