| NPI | 1053561118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME154059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-054314) |
| 207R00000X Internal Medicine (Licence: IL 036.127468) | |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2021-12-22 |