| NPI | 1063402030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91906) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME91906) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2012-10-16 |