| NPI | 1982891529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 062782) |
| 207R00000X Internal Medicine (Licence: VA 0101253711) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2018-06-16 |