| NPI | 1609929405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME101094) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN9476) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-01-17 |