| NPI | 1316168099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 77369) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-08-15 |