| NPI | 1912202599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME134223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 28120-R) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2020-04-24 |