| NPI | 1174596589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME97889) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD059601L) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2012-01-05 |