| NPI | 1619911138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 104703) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01049991) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2009-12-14 |