| NPI | 1306281381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115574) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-01600) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2013-07-18 |