| NPI | 1013292622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 33511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.33511) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2018-03-02 |