| NPI | 1891981734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 246088) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME99933) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2025-08-05 |