| NPI | 1639501265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 137489) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2016-12-14 |