| NPI | 1255695433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036139392) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2020-08-31 |