| NPI | 1255642815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 116677) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 24661) |
| 207R00000X Internal Medicine (Licence: LA MD .206193) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2017-10-10 |