| NPI | 1245440668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME102889) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301086391) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-06-09 |