| NPI | 1881670636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME23128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0023128) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-01-13 |