| NPI | 1760475396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 34959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME123279) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2019-01-22 |