| NPI | 1861688483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 26447R) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2016-09-23 |