| NPI | 1023125556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 34979) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-03-07 |