| NPI | 1124061205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 12,195) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 12195) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-03-02 |