| NPI | 1104803030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141790) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036098048) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2021-03-29 |