| NPI | 1639251309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME100131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD0000027259) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-03-25 |