| NPI | 1861410060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0067577) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 67577) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-05-09 |