| NPI | 1619944600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD21468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 9605) |
| 207R00000X Internal Medicine (Licence: PA MD039667L) | |
| 207R00000X Internal Medicine (Licence: FL ME47497) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-01-06 |