| NPI | 1376983569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125064030) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-07-21 |