| NPI | 1821380544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME150128) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME150128) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2025-05-12 |