| NPI | 1972595254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME94185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301067902) |
| 207R00000X Internal Medicine (Licence: MI 4301067902) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2014-07-29 |