| NPI | 1831445824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127819) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 74660) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2020-10-01 |