| NPI | 1326301722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME145672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015016130) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2024-01-18 |