| NPI | 1407874357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME101036) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-109016) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-10-08 |