| NPI | 1912094442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME162650) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 40109) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-02-27 |