| NPI | 1114901485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 88741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 246085) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-11-04 |