| NPI | 1942485289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME102232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186819) |
| Enumeration Date | 2008-01-06 |
| Last Update Date | 2021-08-31 |