| NPI | 1679591838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME103578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 21574) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-12-10 |