| NPI | 1265766901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME157344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD14539) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2022-10-18 |