| NPI | 1851357131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0088383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2001-89) |
| 207R00000X Internal Medicine (Licence: NH 10452) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-06-06 |