| NPI | 1033214374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 31757) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2013-06-06 |