| NPI | 1104113562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-0797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG154734) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2014-08-06 |