| NPI | 1831356724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 239261) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2018-06-13 |