| NPI | 1902850001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 30716) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-07-19 |