| NPI | 1114959863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME140067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 72912) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-12-29 |