| NPI | 1205057932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME95666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 15427) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2009-05-27 |