| NPI | 1780850743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME158452) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012023203) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-08-22 |