| NPI | 1124020284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 26164) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 26164) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-05-13 |