| NPI | 1114034626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME92537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 49019) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-28 |