| NPI | 1053540203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301109111) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01635) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2018-06-15 |