| NPI | 1255368650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME76665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 76665) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-12-27 |