| NPI | 1609969419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0044391) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME0044391) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-05-09 |