| NPI | 1912994781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME87329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 13794) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2015-10-15 |