| NPI | 1508006610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME116470) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 63113) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2013-12-05 |