| NPI | 1720086945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME138405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 201101764) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2024-02-05 |