| NPI | 1952661803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124929) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN17339) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2015-10-17 |