| NPI | 1154359974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.020831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 020831) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-08-29 |