| NPI | 1811126543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME125993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 14330) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2021-03-31 |