| NPI | 1861798423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251298) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2012-09-17 |