| NPI | 1417939141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME97520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 20030176) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2010-12-06 |