| NPI | 1629091384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111016) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 16463) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2017-01-11 |