| NPI | 1851606966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME120175) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096755) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2018-04-26 |