| NPI | 1932132180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 95007) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 33269) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2022-08-15 |