| NPI | 1770582728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME143198) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 22294) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2022-01-05 |