| NPI | 1609818277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91597) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME91597) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2010-05-07 |