| NPI | 1578776688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 140920) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-08-24 |