| NPI | 1952618951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME116336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057359) |
| Enumeration Date | 2010-09-12 |
| Last Update Date | 2016-08-01 |