| NPI | 1811048622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 15088) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-20 |