| NPI | 1366702441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 005439) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2021-11-23 |