| NPI | 1245255991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0068777) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0068777) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-01-10 |