| NPI | 1083881668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 234730) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2020-12-10 |