| NPI | 1871790329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107114) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11752) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2021-11-18 |