| NPI | 1497844120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME156735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301060391) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-08-05 |