| NPI | 1134357049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159515) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 82198) |
| 207R00000X Internal Medicine (Licence: NC 2010-01715) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-08-08 |