| NPI | 1659353100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME73867) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0073867) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2011-08-24 |