| NPI | 1881666790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 114276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9701174) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-01-05 |