| NPI | 1891733952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME101418) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME101418) |
| 207R00000X Internal Medicine (Licence: FL ME101418) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-09-16 |