| NPI | 1609871805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME73247) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 593554382) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2014-11-26 |