| NPI | 1659427532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME52075) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 45263) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2019-05-21 |