| NPI | 1013110865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 069486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 134942) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2015-06-18 |