| NPI | 1265486476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI AJ066221) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2016-12-19 |