| NPI | 1508121633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301101176) |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2018-01-08 |