| NPI | 1043577059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-02272) |
| Enumeration Date | 2012-04-15 |
| Last Update Date | 2018-06-11 |