| NPI | 1053604124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME135301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098275) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2023-09-27 |