| NPI | 1659457117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 41399) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2015-02-11 |