| NPI | 1639282601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME64528) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101243615) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-06-13 |