| NPI | 1508952862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME147925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 10075) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-10-11 |