| NPI | 1023104049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201401692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 038104) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-07-29 |