| NPI | 1710429410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 43186) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2017-11-08 |