| NPI | 1124306436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME135370) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 44338) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2020-08-26 |