| NPI | 1124147418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS9929) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2013-01-29 |