| NPI | 1780841395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME90945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 10646) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |