| NPI | 1821196064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 45358) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0045358) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-12-06 |