| NPI | 1255320461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 97001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01056818A) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |