| NPI | 1598853574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME88911) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 011896) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-12-21 |