| NPI | 1770535346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121600) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-061209) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-10-10 |