| NPI | 1205850765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 17369) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-06-03 |