| NPI | 1558325266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 44364) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2016-12-13 |