| NPI | 1235218397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110612) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 041418) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-07-21 |