| NPI | 1023019536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 14533A) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-12-29 |