| NPI | 1942301593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME125237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28789) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-01-04 |