| NPI | 1306102983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.207719) |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2023-12-19 |