| NPI | 1053590828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 235120) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2018-04-24 |