| NPI | 1881958908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127594) |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health (Licence: FL ME 127594) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2022-03-03 |