| NPI | 1144589854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME138257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 074363) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2019-02-01 |