| NPI | 1417306366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME171025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A165117) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2025-02-18 |