| NPI | 1407821218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0057999) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME57999) |
| 208D00000X General Practice (Licence: FL ME57999) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2015-09-24 |