| NPI | 1285898288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME117112) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME117112) |
| 207R00000X Internal Medicine (Licence: RI MD12761) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2023-03-07 |