| NPI | 1801114582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109968) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 125.054351) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2015-09-26 |