| NPI | 1710913645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS12476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI DOS-1079) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2015-03-27 |