| NPI | 1558303818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME73901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 0073901) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2009-06-25 |