| NPI | 1972850154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME146272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018039387) |
| 284300000X Special Hospital (Licence: PR 29,093-R) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2022-04-07 |