| NPI | 1790064863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME116422) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME116422) |
| 208D00000X General Practice (Licence: FL ME116422) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2021-10-20 |