| NPI | 1427099456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 11282) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2013-03-25 |