| NPI | 1982903589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 55675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME117449.) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2026-04-09 |