| NPI | 1982873477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME132920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 16613) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2018-05-22 |