| NPI | 1043505969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A131476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 249251) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2014-10-31 |