| NPI | 1558420323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-081216) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2021-07-12 |