| NPI | 1851408538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 96462) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15709) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-05-21 |