| NPI | 1851365274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 89803) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 35632) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2008-11-03 |