| NPI | 1205867058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0081881) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 5624) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2016-08-15 |