| NPI | 1801095054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 31047) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-03-19 |