| NPI | 1104112515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 56526) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL33771) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2016-07-20 |