| NPI | 1336111533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 47902-020) |
| 207R00000X Internal Medicine (Licence: MI 4301085180) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2018-12-04 |