| NPI | 1255355731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111399) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00022083) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-12-19 |