| NPI | 1386754323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME103165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 12953) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-11-14 |