| NPI | 1497843205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN10274) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-08-10 |