| NPI | 1154687507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 128734) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME128734) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-01-12 |