| NPI | 1376532085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME123368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000024006) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-09-03 |