| NPI | 1538488465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115484) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 27711) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2015-01-29 |