| NPI | 1639473515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS10984) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL DO1156) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2012-02-02 |