| NPI | 1194771105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119528) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD060249) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2014-11-04 |