| NPI | 1104137363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME133181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101251012) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2018-06-16 |