| NPI | 1912917501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME122861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 022276) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2021-01-04 |