| NPI | 1083679997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C54750) |
| 207R00000X Internal Medicine (Licence: OH 35079880W) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2019-11-27 |