| NPI | 1801232103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141225) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 191633) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2019-09-05 |