| NPI | 1114220886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A150114) |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2023-10-25 |