| NPI | 1689653453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: FL ME85291) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME85291) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-08-31 |