| NPI | 1720210859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME128378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18595) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2016-08-12 |