| NPI | 1104962505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301099912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 12546) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-07-24 |