| NPI | 1134355670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 352353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 250998) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2012-06-15 |