| NPI | 1760618508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112823) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN13804) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2016-05-09 |